ATTESTATION OF ACTIVITIES*/FORMULAIRE DATTESTATION DACTIVITS

(REGULATION (EC) 561/2006 OR THE AETR) /(RGLEMENT (CE) 561/2006 OU LAETR)

POTVRDA O ODSUSTVOVANJU VOZAA
To be filled in by typing in Latin characters and signed before a journey / Popunjava se u tampanom obliku i potpisuje pre poetka putovanja
To be kept with the original control device records wherever they are required to be kept / uva se uz originalni tahografski listi ili ispis iz digitalnog
tahografa
False attestations constitute an infringement / Unos netanih podataka u potvrdu predstavlja prekraj
Part to be filled in by the undertaking / Popunjava prevoznik
1.

NIZ FENIX DOO

Name of the undertaking / Naziv preduzea /preduzetnika

2.

Korcaginova 13,32300 Gornji Milanovac

Street address, postal code, city / Ulica, potanski broj, grad ......
...........
Country / Drava: Republic of Serbia / Republika Srbija

3.
4.
5.

Telephone number (including international prefix) / Broj telefona

32356778
+381 ......

32356778
+381 .
niz-fenix@open.telekom.rs
Adresse courrier lectronique / adresa elektronske pote):.
Fax number (including international prefix / Broj faksa

I, the undersigned / Ja, dole potpisani:

Zoran Babovic

6.

Name and first name / Ime i prezime:

7.

Direktor
Position in the undertaking / na radnom mestu u preduzeu ..

declare that the driver / izjavljujem da je voza:

Zoran Damljanovic

8.

Name and first name / Ime i prezime vozaa..:...

9.

21.01.1977 g.
Date of birth (day/month/year) /Datum roenja: (dan/mesec/godina): ..

10.

Driving licence or identity card or passport number / Broj vozake dozvole line karte ili pasoa

011936624 pas.
.
11.

who has started to work at the undertaking on (day/month/year) / koji je otpoeo sa radom u preduzeu (dan/mesec/godina)

15.04.2015 g.

au cours de la priode / za period:

12.

16.00h, 13.01.2016 g.

from (hour/day/month/year) / od(as/dan/mesec/godina):

13.

17.00h, 14.01.2016 g.
to (hour/day/month/year) / do (as/dan/mesec/godina):

14.

was on sick leave* / bio na bolovanju*

15.

was on annual leave* / koristio godinji odmor*

16.

was on leave or rest* / odsustvovao sa posla ili koristio slobodne dane*

17.

drove a vehicle exempted from the scope of Regulation (EC) 561/2006 or the AETR* / upravljao vozilom koje nije iz oblasti AETR-a*

18.

performed other work than driving* / obavljao druge poslove osim upravljanja vozilom*

19.

was available* / bio raspoloiv *

20.

13.01.2016 g
Place / Mesto:.... Date / Datum:

Gornji Milanovac

Signature / Potpis:.

21.

22.

I, the driver, confirm that I have not been driving a vehicle falling under the scope of Regulation (EC) 561/2006 or the AETR during the
period mentioned above / Ja, voza, potvrujem da nisam upravljao vozilom iz oblasti AETR-a tokom gorepomenutog perioda.

13.01.2016 g.
Gornji Milanovac
Place / Mesto:.
Date / datum.........................

Signature of the driver / Potpis vozaa:

...................................................................................................

Choose only one box/ Izabrati jednu od ponuenih opcija.